In a health care enterprise physicians, nurses, clinicians and/or other health care providers constantly request or order medications and services in the course of providing patient care. Traditionally orderable item requests have been written by hand by the clinician requesting the medication or service. In order to improve healthcare safety and efficiency, however, computerized provider order entry (CPOE), which requires that orderable items be retrieved from a hospital computer system database containing a list of available orderable items, has been widely proposed as a critically important function.
However at present only a small percentage of hospitals have implemented CPOE. The cultural change involved in persuading physicians and other clinicians to enter orders electronically, rather than by hand, is so disruptive that hospitals are reluctant to undertake such a project. This is primarily due to the considerable extra time consumed in entering the orders via a computer. Instead, to implement CPOE systems, health care enterprises have hired full time clerks specifically to take the hand written orders of physicians and simply enter them into the computer, thereby negating much of the benefit of CPOE.
The time a clinician takes to locate and enter orders for a patient via a CPOE system is dependent on many factors, such as the time taken to find a computer terminal, the time to log on, the time to find the order function screen, the time spent pondering which order might be appropriate, the time spent finding the desired order in the catalog of orders, the time needed to fill out details of the order, the time to resolve conflicts and error messages within the order and the time needed to confirm and sign the order. Two of these factors, finding the desired order and filling out order details, form the bulk of the frustration associated with clinician acceptance of CPOE.
Several methods are typically implemented to allow a clinician to find and select an order from among the order choices available in the CPOE database. One method to allow a clinician to find and select an order from among the order choices available in the CPOE database is searching. A search engine is a program that defines sets of related items that will be created in response to a user input of a string, termed a “search string” or “search term”. Typical search methods generally involve simple pattern matching of the search string with the entire orderable item name associated with that orderable item. A simple pattern match searches for the search string as sequential characters in a larger string. If that search string is found, the item is selected. For example a search for “%IDE%” matches “ChlorIDE” “FluorIDE” and “AntIDEpressant”.
Searches are typically judged by precision and recall. Precision is defined as the ratio of the number of relevant records retrieved to the total number of records, irrelevant and relevant, retrieved. Recall is defined as the ratio of the number of relevant records retrieved to the total number of relevant records in the database. Simple pattern matching has low recall and low precision. Simple pattern matching has low recall because in order to retrieve an orderable item the search string needs to exactly match the service name, but the exact wording and punctuation of the service name is unknown to the user. For example, a user may wish to enter search pattern “two view chest x-ray” when the orderable item service name is actually “XR: Chest, AP/Lat Views”. The pattern does not match and so the computer does not retrieve the service item. To be successful the user must speculate about the ordering and punctuation of the service item, or be trained regarding CPOE system search rules including all of the exceptions, or enter less information in the search request. The latter strategy defeats the purpose of a search which is typically to locate uncommon items not appearing on the commons list. Spelling errors, both in the CPOE system and the search string entered by the user, exacerbate this problem.
Simple pattern matching has low precision because the strategy for improving recall is to include less search information. In the previous example if the user searches for “chest” without the word x-ray, the order may be found. But, there are very many services that match chest, so the user is left with many irrelevant entries. This entails a very high reading load associated with scanning down the list of search results until the correct service item is found. The problem is aggravated by the fact that the results are typically ordered alphabetically rather than by relevancy. This implies that users need to read the entire list to determine that the search failed to return a valid result. Further, the search results may on occasion suggest the use of a sub optimal but similar orderable item that is listed first. For example, a user might choose a service for “XR: Chest, & Ribs, PA/Lat Views” despite the fact that no Rib Views were needed, rather than the more appropriate “XR: Chest, PA/Lat Views”, simply because the list was long and the more appropriate choice was lower on the list. Given the ineffective search strategies, most physicians find it faster to write the order by hand and have the unit secretary perform the search.
A need therefore exists to improve the operation of search engines. Any such improvement has great potential for significantly increasing physician satisfaction and acceptance of CPOE systems. A computerized search system constructed according to the principles of the present invention addresses the foregoing deficiencies and related problems.